Virginia Licensed Fraud Investigator

Job Summary

To support investigations into suspected fraud and abuse, the full-time Virginia Licensed Fraud Investigator will conduct in-depth analyses, interviews, and audits remotely while working a standard schedule of 8 am to 5 pm EST, Monday through Friday, with occasional travel to Virginia Beach.

Key responsibilities

• Identify, investigate, and evaluate instances of potential fraud, waste, and abuse across various interactions
• Conduct interviews and correspond with relevant parties to determine the outcome of claims or reviews
• Analyze gathered information and present findings and recommendations in written formats

Required qualifications

• Bachelor's degree preferred
• Certified Professional Coder (CPC) preferred or to be achieved within 12 months of hire
• 2 years of combined experience in Internal/External Audit, regulatory/compliance, or healthcare preferred
• Experience in reviewing claims and analyzing data for billing irregularities preferred
• Familiarity with healthcare claims and fraud, waste, and abuse concepts preferred